Kalchev Y, Petkova Ts, Raycheva R, Argirova P, Stoycheva M, Murdjeva M
Department of Microbiology and Immunology, Faculty of Pharmacy, Medical University - Plovdiv, Bulgaria; Laboratory of Microbiology, St. George University Hospital - Plovdiv, Bulgaria.
Laboratory of Virology, St. George University Hospital - Plovdiv, Bulgaria.
Cytokine. 2021 Apr;140:155423. doi: 10.1016/j.cyto.2021.155423. Epub 2021 Jan 24.
Central nervous system infections (CNS) are life-threatening diseases, with meningitis being the most common. Viral infections are usually self-limiting diseases but bacterial pathogens are associated with higher mortality rates and persistent neurological sequelae. We aimed to study the role of IL-6, IL-8, IL-10, IL-12(p40), TNF-α cytokines, classical cerebrospinal fluid (CSF) parameters, and serum C-reactive protein levels (CRP) for discriminating bacterial from viral central nervous system infections.
This prospective study included 80 patients with clinical signs and abnormal cerebrospinal fluid laboratory findings typical for neuroinfection admitted to St. George University Hospital-Plovdiv. Routine methods such as direct microscopy, culturing and identification were used for microbiological analysis as well as latex-agglutination test and multiplex PCR. Cytokines' concentrations were measured by ELISA. CRP and CSF parameters were collected from the patients' medical records.
We observed the highest discriminatory power among cytokines for cerebrospinal IL-12(p40) (AUC = 0.925; p = 0.000). CSF protein levels were the best predictor for bacterial neuroinfection (AUC = 0.973; p = 0.000). The AUC for the serum CRP as a stand-alone biomarker was estimated to be 0.943. The discriminatory power can be increased up to 0.995 (p = 0.000) when combining cerebrospinal fluid IL-12(p40) and serum CRP, with an optimal cut-off value of 144 (Sensitivity 100%; Specificity 90.9%).
The combined testing of CSF IL-12(p40) and serum CRP is associated with the highest diagnostic accuracy.
中枢神经系统感染（CNS）是危及生命的疾病，其中脑膜炎最为常见。病毒感染通常为自限性疾病，但细菌病原体与更高的死亡率和持续性神经后遗症相关。我们旨在研究白细胞介素-6（IL-6）、白细胞介素-8（IL-8）、白细胞介素-10（IL-10）、白细胞介素-12（p40）、肿瘤坏死因子-α（TNF-α）细胞因子、经典脑脊液（CSF）参数以及血清C反应蛋白水平（CRP）在鉴别细菌性与病毒性中枢神经系统感染中的作用。
这项前瞻性研究纳入了80例因神经感染入住普罗夫迪夫圣乔治大学医院且具有典型临床症状和脑脊液实验室检查异常结果的患者。采用直接显微镜检查、培养和鉴定等常规方法进行微生物分析，以及乳胶凝集试验和多重聚合酶链反应。通过酶联免疫吸附测定法测量细胞因子浓度。从患者病历中收集CRP和CSF参数。
我们观察到脑脊液中白细胞介素-12（p40）在细胞因子中具有最高的鉴别能力（曲线下面积[AUC]=0.925；p=0.000）。脑脊液蛋白水平是细菌性神经感染的最佳预测指标（AUC=0.973；p=0.000）。血清CRP作为单一生物标志物的AUC估计为0.943。当联合脑脊液白细胞介素-12（p40）和血清CRP时，鉴别能力可提高至0.995（p=0.000），最佳截断值为144（敏感性100%；特异性90.9%）。
脑脊液白细胞介素-12（p40）和血清CRP的联合检测具有最高的诊断准确性。
